BILL ANALYSIS
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|Hearing Date:July 9, 2007 |Bill No:AB |
| |1486 |
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SENATE COMMITTEE ON BUSINESS, PROFESSIONS AND ECONOMIC
DEVELOPMENT
Senator Mark Ridley-Thomas, Chair
Bill No: AB 1486Author:Charles Calderon
As Amended:June 26, 2007 Fiscal: Yes
SUBJECT: Licensed professional counselors.
SUMMARY: Provides for the licensing and regulation of
professional counselors by the Board of Behavioral Sciences
(Board).
Existing law:
1)Provides for the licensing and regulation of the practice
of psychotherapy preformed by marriage and family
therapists (MFTs), licensed educational psychologists
(LEPs), and licensed clinical social workers (LCSWs) by
the Board of Behavioral Sciences (Board) within the
Department of Consumer Affairs.
2)Provides for an 11 member Board, consisting of:
a) 5 professional members (all Governor appointees)
consisting of:
2 LCSW licenses
1 LEP licensee
2 MFT licensees
b) 6 public members consisting of:
1 Senate Committee on Rules
1 Speaker of the Assembly
4 Governor
3)Defines a psychotherapist as a physician and surgeon
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specializing in psychiatry or practicing psychotherapy, a
psychologist, a clinical social worker, a marriage and
family therapist, a psychological assistant, a marriage
and family therapist registered intern or trainee, or an
associate clinical social worker.
4)Establishes the following general requirements for
licensure of psychotherapists:
a) A graduate degree from an accredited school in a
related clinical field.
b) Extensive hours of supervised experience gained
over a specified number of years.
c) Registration with the Board while gaining the
supervised experience.
d) Standard and Clinical Vignette licensing
examinations.
5)Defines the practice of marriage and family therapy as
service performed with individuals, couples, or groups
wherein interpersonal relationships are examined for the
purpose of achieving more adequate, satisfying, and
productive marriage and family adjustments.
6)Defines the practice of clinical social work as service
in which a special knowledge of social resources, human
capabilities, and the part that unconscious motivation
plays in determining behavior, and service that is
directed at helping people achieve more adequate,
satisfying, and productive social adjustments.
7)The Child Abuse and Neglect Reporting Act, requires a
mandated reporter to report whenever he or she has
knowledge of or observes a child whom the mandated
reporter knows or reasonably suspects has been the victim
of child abuse or neglect.
This bill:
1)Creates the Licensed Professional Counselors Act (Act)
that provides for the licensing and regulation of
licensed professional counselors (LPCs), as defined, by
the Board.
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2)Defines professional counseling as the application of
psychotherapeutic techniques, and mental health or human
developmental principles, through assessment, cognitive,
affective, behavioral, verbal or nonverbal, or systemic
intervention strategies, consistent with scope,
coursework and training required by the Act, and that
address wellness, personal growth, adjustment to
disability, crisis intervention, as well as pathology,
and empower individuals to deal adequately with life
situations, reduce stress, experience growth, and make
well informed, rational decisions.
3)Restricts a professional counselor to the use of specific
methods, techniques, or modalities he or she has the
appropriate education and training, and to only those
assessment activities they are qualified to perform by
education and training.
4)Prohibits a person from practicing or advertising
professional counseling services without a license from
the Board, and excludes from the Act:
a) Persons, not otherwise licensed to perform
counseling services, who do not use the title
"licensed professional counselor" or who do not
represent themselves as licensed to practice
professional counseling.
b) The provisions of the Medical Practice Act, the
Clinical Social Worker Practice Act, the Nursing
Practice Act, the Psychology Licensing Law, or
marriage and family therapy licensing laws.
c) Any priest, rabbi, or religious minister who
performs counseling services as part of his or her
pastoral or professional duties.
d) Any person who is admitted to practice law in this
state, or is licensed to practice medicine, and who
provides services as part of his or her professional
practice.
e) An employee of a governmental entity, school,
college, university, or nonprofit charitable
institution, if his or her practice is preformed
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solely under the supervision of the entity, school,
or organization by which he or she is employed, and if
the functions are performed as part of the employment.
5)Specifies educational and experience requirements for
applicant qualification, including a master's or doctor's
degree from an accredited or state approved school in
counseling or a closely related subject.
6)Provides that the Board shall make the final
determination as to whether a degree meets all
requirements, including, but not limited to, course
requirements, regardless of accreditation.
7)Authorizes the Board to issue an LPC license to any
person who has met the following requirements:
a) Holds a master or doctoral degree in counseling, or
a closely related degree, as specified.
b) Completes 3,000 hours of supervised experience in
the practice of professional counseling.
c) Passes the examinations approved by the Board.
d) Meets other regulatory requirements, including:
i. not having committed acts or crimes that
would be grounds for denial.
ii. not having been convicted of a crime that
involves sexual abuse of children.
iii. passing a fingerprint check through the
Department of Justice.
8)Authorizes the Board to issue an LPC license to any
person who has held for at least two years a valid
license as a professional counselor, or an equivalent
title, in another jurisdiction of the United States, if:
a) The education and supervised experience
requirements are substantially equivalent.
b) The applicant has passed the examinations approved
by the Board.
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c) The applicant pays the required fees.
9)States that it is the intent of the Legislature that a
national licensing examination be evaluated by the Board
as a requirement for LPC Licensure.
10)Permits the Board, under a grandparenting provision, to
issue an LPC license to any person who meets specified
education, coursework, experience, and examination
requirements between October 1, 2008 and March 31, 2009,
and requires specified documentation to be provided to
the Board within 12 months for evaluation.
11)Provides that a license issued under the grandparenting
provision of the bill shall be valid for six years from
the date of issuance, and upon application for renewal,
requires the applicant to pass an examination approved by
the Board.
12)Authorizes an individual who meets certain coursework
requirements, and who is currently licensed as a MFT or a
LCSW to obtain a LPC license under the grandparenting
provision. Those who have become licensed in this manner
are not required to pass the examination required in # 11
above.
13)Requires the Board to accept applications for LPC intern
registration on January 1, 2009.
14)Requires the Board to accept applications for LPC
licensure beginning January 1, 2010.
15)Requires the Board to report each month to the State
Controller the amount and source of all revenue received
under the Act and deposit the entire amount in the State
Treasury for credit to the Behavioral Sciences Fund
(Fund).
16)Provides that the Board is not required to implement the
provisions of this bill until funds have been
appropriated from the Fund, as a loan, by the
Legislature.
17)Requires the Governor to appoint two LPCs to the Board,
and two additional public members.
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18)Adds LPCs to the list of mandated reporters under the
Child Abuse and Neglect Reporting Act.
FISCAL EFFECT: The Assembly Appropriations analysis, dated May
9, 2007, indicates that the Board estimates creating this
licensing category will require approximately $525,000 for the
first year, with annual costs of $850,000. The Board also
estimates that revenue generated by licensing fees will almost
offset the cost of this bill in the first year. For the long
term, however, the Board estimates the LPC category will
generate almost $1.6 million in fee revenue per year; almost two
times the cost of the program.
COMMENTS:
1.Purpose. This bill is sponsored by the California
Coalition for Counselor Licensure (CCCL, Sponsor) which
is comprised of 10 counseling associations in California.
CCCL has identified a number of workforce issues that
they believe licensure of LPCs would address. They cite
the 2003 California Workforce Initiative report The
Mental Health Workforce: Who's Meeting California Needs?
which states that unlicensed providers are meeting much
of the mental health needs of Californians, and the
problem is obtaining third-party reimbursement. The
study further points out that the state will need an
additional 13,000 to 20,000 mental health professionals
by the year 2010.
CCCL also explains that there is a shortage of mental
health providers in rural areas to treat Medi-Cal
beneficiaries, and this shortage could increase due to
the passage of Proposition 63, which potentially will
double the number of clients served. Proposition 63, the
Mental Health Services Act (MHSA), passed in 2004,
expands mental health care for children and adults
through a 1% tax on taxable personal income over $1
million.
Recent news articles have reported that many counties are
receiving money from MHSA, far beyond what was projected.
Yet, counties are finding it hard to recruit qualified
staff. According to CCCL, "In terms of sheer numbers,
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the MFTs and LCSWs can fill the positions; however, they
are not filling those positions currently. LPCs
curricula prepare them to readily adapt to the needs of
the public mental health system under the principles of
MHSA."
Background provided by the Author's office states that
master-level counselors are employed in 36 county mental
health departments throughout the state, yet, without a
license, there are limits to the services they can
provide and the county cannot receive reimbursement
unless the counselor is licensed.
According to CCCL, 49 other states license Professional
Counselors. The State of Nevada enacted legislation on
June 14 of this year to become the 49th state to license
LPCs; leaving California as the only state without
licensure.
2.Federal Legislation. In 2006, the President signed the
Veterans Benefits, Health Care, and Information
Technology Act, recognizing LPCs as counseling providers
to improve outreach and access to services for veterans.
3.Hurricane Katrina Assistance. In 2005, the American
Counseling Association received a larger federal grant to
help facilitate the immediate deployment of LPCs to
Louisiana to provide mental health services for hurricane
survivors. Volunteers participating in the effort were
required to hold a state license as a professional
counselor. According to CCCL, federal grant guidelines
did not allow any exemptions from this requirement.
Therefore, none of California's thousands of mental
health counselors qualified (unless they were licensed in
another state). The professional counselors deployed
provided mental health services to individuals, families
and children affected by the devastating effects of
Hurricane Katrina. They helped clients cope with crisis
(including suicidal ideation and substance abuse), post
traumatic stress disorder (PTSD) symptoms, grief and
loss, as well as assessing the need for both immediate
and long-term intervention.
4.Related Legislation. AB 894 (La Suer) of 2005, similarly
provided for the licensing and regulation of professional
counselors by the Board. AB 894 was held in the Assembly
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Appropriations Committee. The sponsor of AB 894, also
CCCL, has worked with a number of stakeholders during the
last year and substantially amended the original language
contained in AB 894 to address many concerns of the
opposition. AB 1486 is a product of negotiations between
the proponents and opponents of AB 894, although some
opposition remains.
(ACR 231 (Yee), passed in 2004, documented the shortage and
the expected demand for an additional 3, 000 to 20,000
mental health workers by the end of this decade. The LPC,
trained as a generalist, is poised to address the diverse
counseling needs of consumers. The U.C. San Francisco
study, "The Mental Health Workforce: Who is Meeting
Califomia"s Needs?" specifically recommended that
legislative and regulatory barriers be removed for
master's-level LPCs, as other states have done.
5.Sunrise Hearing. Subject heard by the Joint Committee in
2006. The issues presented in AB 894 were part of
"Sunrise Review" by the Joint Committee on Boards,
Commissions, and Consumer Protection (Joint Committee) in
2006. However, the Joint Committee was unable to reach a
consensus necessary to either support or oppose the
licensure and regulation of professional counselors.
6.Arguments in Support.
CCCL argues that LPC licensure would meet the needs of a
number of California individuals who do not fit into the
structure of MFT or LCSW counseling. Furthermore, CCCL
notes that while it has been argued that the scope of
practice for LPCs is overly broad, it should be noted
that the scope is very comparable to the current scope of
MFTs.
Furthermore, CCCL states that no practitioner, regardless
of his or her particular license, can provide services
for which he or she has not had the education and
training to assure quality and treatment. The 2005 Code
of Ethics of the American Counseling Association
addresses the matter of boundaries of competence stating,
"Professional counselors are restricted to the use of
specific methods, techniques, or modalities for which
they have the appropriate education and training.
Professional counselors are obligated to refer clients to
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other mental health professionals when they identify
issues beyond their own scope of education, training,
supervision, and/or experience."
CCCL further argues that LPC education and training
standards for licensure are on par with those of the
other two masters level mental health providers, MFTs and
LCSWs who have providing psychotherapy for many decades
in California. These standards are also on par with
national standards that regulate over 100,000 LPCs across
the country.
CCCL points out that in some respects LPC licensure is more
demanding than MFT licensing qualifications. LPC
licensing would require 3,000 hours of supervised
experience post-degree. MFT licenses require 3,000 hours
of supervised experience, 1,300 of which can be earned
pre-degree.
According to the American Association of State Counseling
Boards (AASCB), "States have been licensing professional
counselors for 30 years. Currently over 100,000 masters
and doctoral-degreed professional counselors are licensed
to practice independently in 48 states and the District
of Columbia." AASCB concurs with the National Board for
Certified Counselors and Affiliates stating, "AB 1486
closely follows the requirements used by other states for
licensure of professional counselors. Requirements
include educational standards, post-degree supervision, a
standard national examination, and provisions for ongoing
continuing education. As with other health and social
services professions, states have adopted such
requirements in order to protect the public and to endure
a minimum level of competence for individuals seeking
counseling."
After the June 18 amendments, the Board of Behavioral
Sciences (Board) now supports the bill, stating that the
bill "establishes licensing requirements that are
substantially equivalent to licensing standards for
Marriage and Family Therapists and Licensed Clinical
Social Workers, comparable professions that the Board
currently regulates." In addition, "The Board supports
licensure of professional counselors in California for
reasons both human and economic. According to the World
Health Organization, mental illness is the second leading
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cause of disability worldwide. Many people in need of
mental health services are unable to access such services
or do not receive enough help, and LPCs would be another
resource to help address this problem." The Board
concludes, "There are many clinically trained counselors
in California who are competent to provide mental health
services, but cannot provide those services because they
cannot be licensed here. This bill would provide these
counselors with a path to licensure in California."
The California Psychiatric Association , representing over
3,100 psychiatrists in California, states that under AB
1486 licensed professional counselors will be uniquely
suited to engage in collaborative work with psychiatrists
(and other mental health professionals) in county mental
health systems, state institutions and in private
practice.
Pointing out that AB 1486 emphasizes the obligation of LPCs
to refer "when they identify issues beyond the scope of
their education, training, supervision and experience,"
the Association states, "The educational requirements and
training experiences in the bill will tend to put LPCs in
direct contact with psychiatrists. As they learn from
and are supervised by psychiatrists, a foundation for
future collaboration will be established."
The California Registry of Professional Counselors and
Paraprofessionals writes that it has been certifying
counselors in California since 1990, but can only offer a
voluntary credential, which does not have the weight of
law behind it to enforce accountability. Even though
registered counselors have met the professional standard,
it is argued that their practice is restricted without
licensure. "The Registry is contacted every day by
counselors licensed in other states, who are unable to
practice their profession in California, because there is
not a license available to them."
California Counseling Association and the Southern
California Chapter of the American Dance Therapy
Association contend that "Passage of this measure will
address our state's mental health workforce shortages,
Prop 63 implementation issues, the lack of professional
and cultural diversity among mental health workers to
reflect the changing needs and demographics in our state,
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the lack of portability of professional credentials
causing restraint of trade issues, and finally, as a
matter of parity and equity, this measure will provide
equal access to the professional options that licensure
affords for counselors who are comparably trained to
current licensees." The California Mental Health
Counselors Association , adds, "Counselor education
programs in California Universities have a high rate of
minority students in their programs and would provide an
excellent addition to the mental health workforce, who is
dependent on licensed personnel."
7.Arguments in Opposition.
The California Psychological Association (CPA) has an
Oppose Unless Amended position and indicates that while
it is not opposed to licensing for counselors, it does
have concerns about a number of provisions in AB 1486.
Scope of Practice . CPA argues that the proposed scope of
practice for this master's level training is as broad as
a doctoral-level psychologist's. However the educational
requirement for LPC licensure will be a Master's degree
in counseling or a "closely related degree."
CPA further contends that the scope of practice is
infinitely expandable without any additional approval by
the Legislature, stating that the scope of practice will
include any activity "consistent with scope and
coursework and training required in subdivision (c) of
Section 4999.32." CPA argues that this sentence allows
ANY practice or procedure solely on the basis of a course
description, a survey course or an introductory course.
"Scopes of practice must be specific in the law and not
include ambiguous language that would allow activities
that were not explicit when the Legislative policy
committees considered the bill." CPA asks that the scope
of practice be clear, specific and unambiguous and that
all language be deleted that would allow expansion of the
scope of practice without returning to the Legislature.
Psychological Testing . CPA has argued that the
psychological testing described in the definition of
assessment in Section 4999.12 was a complex specialty
that requires specific and comprehensive training and has
requested specific amendments to address their concerns.
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However, Committee Staff notes that the definition of
assessment was amended on June 18, in an effort to
satisfy CPA's concerns on this issue.
Related Degrees . CPA points out that eligibility for the
proposed LPC license will be anyone with a master's
degree in counseling or a "closely related degree." CPA
indicates that only 12 states permit a "related degree"
as academic preparation for an LPC. "Related degrees
include, but are not limited to, rehabilitation, art
therapy, school counseling, dance or movement therapy or
career development. All individuals with these degrees
would be licensed to practice psychotherapy under one
general license." CPA argues that for consumer
protection purposes, all references to including
individuals with "related degrees" should be removed from
the bill.
Grandparenting Provisions . CPA remains concerned that
individuals who will receive the license through the
grandparenting provision of the bill may not have
received academic training intrinsic to the counseling
degrees proposed as a qualification for this license.
CPA states that individuals who have earned only five of
the nine core competencies during a Master's program
would be allowed to gain the additional four courses
post-degree to qualify for licensure. These courses
would not be a part of the comprehensive curriculum.
Further, passage of the examinations would not have to
occur until SIX years after the grandparented-in LPC
would begin practice. CPA contends that the bill creates
"a situation where an LPC failing the examination and not
qualified to provide services could have been engaged in
psychotherapy with a patient for SIX years."
Exclusion of Exam Requirements for MFTs and LCSWs . Most
puzzling to CPA, is the exclusion of examination criteria
for MFT and LCSW licensees. CPA states that this
provision is a lenient avenue for MFTs and LCSW s to
become dually licensed as LPCs. The practicing MFT or
LCSW would only have to show verification of core
coursework to become a licensed LPC without having to
pass either of the Board-approved examinations, which is
vital to determine the baseline competency of
practitioners. CPA states that if the justification for
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excluding the MFTs and LCSW s from the examination
requirements is that the education and training are so
similar that it would be a redundant and an unnecessary
step, then the need for an LPC license must be re-thought
in the first place.
The American Association for Marriage and Family
Therapy?California Division (AAMFT) argues in opposition
that AB 1486 risks harming the public by providing
counselors practice rights in excess of their education
and training; risks harming the public by reducing the
public mental health workforce; does nothing to enhance
the quality of mental health services in the State of
California; and is based on unfounded claims related to
licensure need, workforce impact, and; the nature of the
counseling profession.
AAMFT argues "grandparenting is usually designed to grant
practitioners who have demonstrated competence through
years of practice the ability to continue practicing. In
this case, counselors are already providing services in
different forums, and wouldn't lose their jobs, but
inexplicably AB 1486 lowers the standards during
grandparenting, most incredibly lowering the experience
requirements, and opens the door to non-clinical
practitioners. Such provisions confuse and threaten the
public because consumers will not know which threshold of
education and training the counselor has met."
AAMFT further indicates that the reciprocity language does
not adequately protect the public, but allows individuals
from another state to qualify for a license in California
if they've had a license for two years and have
experience and education similar to California's
requirements, but does not require out-of-state
applicants to take California-specific coursework in
alcoholism, human sexuality, psychopharmacology,
psychological testing, spousal abuse, and child abuse, as
required by other disciplines.
AAMFT believes the bill risks harming the public by
reducing the public mental health workforce, contending
that many counselors already work in the public mental
health system in license-exempt settings. "Many
practitioners in exempt settings will get a license and
move into private practice where they will not be
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accessible to the same population through Medi?Cal and
will drive up costs to the most neediest by requiring
out-of-pocket payments.
8.CAMFT Is Neutral on the Bill. The 29,000 member
California Association of Marriage and Family Therapists
(CAMFT) has removed its opposition based upon amendments
made in the Assembly to allow this emerging field to have
higher standards of practice, and more protections of the
consumer. CAMFT indicates that the sponsors of the
legislation have taken numerous amendments to accommodate
their concerns.
CAMFT states, "At some time in the future, we project that
there will only be one masters level profession in
California, with individuals specializing within that
license. Thus, those who wish to specialize in systems
work will do so; those who wish to specialize in art
therapy will do so, etc. The current system with a
variety of acronyms is confusing for consumers who just
want to be helped and do not perceive greater value from
one professional compared to the next."
9.Recent Amendments: Removing the Misdemeanor Penalty.
The June 26, 2007 amendments by the sponsor were intended
to address concerns raised by Public Safety Committee,
which had asserted jurisdiction over the bill because the
bill proposed to add a new misdemeanor crime for any
person who violated the act. The Public Safety
Committee's consideration of Receivership/Overcrowding
Crisis Aggravation (ROCA) Implications, due to the
current extraordinary and severe prison and jail
overcrowding crisis in California has caused it to hold a
number of bills that could result in additional prison or
jail overcrowding.
Therefore, this bill was amended to provide that violation
of the chapter is subject to a civil penalty of up to
$3,500 for each violation and to remove the misdemeanor
crime from the bill.
This amendment has engendered concern by those who oppose
the bill, who argue that this bill would create a
standard for those who violate the LPC law that is not
equal to other licensing laws in the Business and
Professions Code. Indeed, professional licensing acts
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generally provide that any violation of the act is
misdemeanor.
Although the misdemeanor issue is a legitimate
consideration, the Committee may wish to focus its
attention on the greater policy issue of licensure of
licensed professional counselors. As the agency that
will enforce the LPC law, as well as the MFT and LCSW
licensing laws, the Board has indicated that it is not
greatly concerned with the amendment.
NOTE: Double-referral to Public Safety Committee second.
SUPPORT AND OPPOSITION:
Support:
California Coalition for Counselor Licensure (CCCL,
sponsor)
Board of Behavioral Sciences
American Art Therapy Association
American Association of State Counseling Boards
American Counseling Association
American Counseling Association, Western Region
American Dance Therapy Association
American Mental Health Counselors Association
American Rehabilitation Counseling Association
Association for Counselor Education and Supervision
Association for Play Therapy
California Association of School Counselors
California Career Development Association
California Mental Health Counselors Association
California Psychiatric Association
California Registry of Professional Counselors and
Paraprofessionals
California Rehabilitation Counseling Association
Commission on Rehabilitation Counselor Certification
Mental Health Association in California
National Board for Certified Counselors
National University, Department of School Counseling
Northern California Art Therapy Association
Western Association for Counselor Education and Supervision
Numerous individuals
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Opposition:
American Association For Marriage and Family
Therapy-California Division
Citizens Commission on Human Rights
Oppose Unless Amended:
California Psychological Association
Central Coast Psychological Association
Contra Costa Psychological Association
Los Angeles County Psychological Association
Pacific Cascade Psychological Association
Santa Clara County Psychological Association
Numerous individuals
Consultant:G. V. Ayers